Just wanted to let it out in a safe place. My dad has been in the MICU for over a week with a GI bleed and septicemia...also on the liver transplant list. He grew out MRSA in his sputum, ascites, liver abscess, and blood. Basically overwhelming sepsis. They decided to aspirate a cyst on his liver and also placed a drain. He was considered a border and was possibly going to be transferred to the floor, but the next day he was really agitated and thanked his nurse for the care he got and everything they did for him...she was like "Where ya goin'? and decided to change his assignment to an ICU nurse instead of an acute care float. This was Thursday. He basically respiratory arrested and was intubated later that night. Huge hospital-acquired bilteral pneumonias (believed to be partly aspiration), bilateral pleural effusions, and the intensivist believes they may have somehow created a fistula during the liver aspiration procedure he had done. Has been on Levo which they were able to back off from, but his O2 requirements are increasing. They had him down to 60% FiO2 but 10 of PEEP. Decompensated during the night and is up to 80% FiO2 and 12.5 of PEEP, and has been retaining serious fluid since Friday...he's positive over 5 liters and third spacing like crazy....less than 10 ml/hour for urine output...they called me today to consent for an IJ catheter for Prisma CRRT.
I am his healthcare proxy because my mom feels like she can't make an informed decision and doesn't understand what they tell her, even when it's in layman's terms. She's very overwhelmed, and I feel very inadequate making life and death decisions for my dad. I talked to his nurse today and I asked her to be honest as far as the CRRT and whether she thought it was futile, and she said in her opinion she didn't believe it would make much of a difference for him but that she has seen patients sicker than him recover with a transplant. She also said that he won't recover without a transplant, but he's ineligible for it right now because of the sepsis. Has to be off antibiotics for a week to be put back on. His blood cultures from 6/1 came back negative but his pneumonias are worse, they did a bronchoscopy and aspirated huge amounts of purulent secretions. My dad was a DNR prior to getting on the transplant list because he didn't want to live like this. The nurse said they will want to trach him in the next few days, but I absolutely know he wouldn't want that, and I don't want keep holding out for him for that 1% miracle chance. He watched his father die the exact same way from a medical error and it went on for almost a year before his blood pressure just wouldn't sustain even on max amounts of pressors. My dad has made it clear he doesn't want us to do that to him, but I also don't want to be too hasty since it's only been a few days. His nurse was very honest and said she doesn't know if he'll get off the vent at all without the transplant, definitely not soon or before getting a trach, and that he has very little hope unless the sepsis clears and he gets to the top of the list quickly. I just feel like I'm walking such a thin line. I don't want to be responsible for giving up on him too soon, but I know too much from a medical perspective to believe that his overwhelming sepsis is going to clear and he'll magically start improving, especially when he's on triple antibiotics and not responding to 2 grams of vanco BID. When do you say when? I just can't believe this is happening to him. I don't know what's heavier, my head or my heart.
